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Assigned Counsel Application Form Pro Hac Vice Admission To The CJA Panel Form. This is a New York form and can be use in District Court Federal.
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Tags: Assigned Counsel Application Form Pro Hac Vice Admission To The CJA Panel, New York Federal, District Court
UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF NEW YORK
CJA PANEL
Application for Pro Hac Vice Admission to the CJA Panel
PLEASE COMPLETE THE ATTACHED CRIMINAL JUSTICE ACT
PANEL APPLICATION FORM.
~~~~~~
PLEASE RETURN THE COMPLETED FORM TO:
LAWRENCE K. BAERMAN, CLERK
UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF NEW YORK
P.O. BOX 7367
100 SOUTH CLINTON STREET
SYRACUSE NY 13261-7367
ATTN: Tracey Donovan
American LegalNet, Inc.
www.USCourtForms.com
UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF NEW YORK
CRIMINAL JUSTICE ACT
ASSIGNED COUNSEL APPLICATION FORM - Pro Hac Vice Admission to the CJA Panel
1) Name: ______________________________________________________________________________________
(LAST)
2) Firm Name:
(FIRST)
(MIDDLE INITIAL)
____________________________________________________________________________
3) Office Address:____________________________________________________________________________
_________________________________________________________________________________________
(CITY)
(STATE)
(ZIP CODE)
4) County:__________________________ NDNY Bar Roll No:_____________________________________
5) Office Telephone No.: (_____)____________ Fax Number:(______)_______________________________
6) Home Telephone No: (_____)____________ E-Mail Address:____________________________________
7)* Federal Tax Identification No.: __________________
7A)* Social Security No.: ___________________
8) Education:
Law School:_____________________________________________________________
Date:__________
9) The highest court to which you are admitted: ______________________________ Date: _______________________
10) _____ This will be my first CJA Panel assignment in the NDNY.
11) _____ I am familiar with the current NDNY Local Rules & the Fed.R.Crim.P.
12) _____ I have never been censured or suspended from practice.
Dated: ____________________
____________________________________
Signature
* IF USING A LAW FIRM EMPLOYER IDENTIFICATION NUMBER, YOU MUST ALSO PROVIDE YOUR
SOCIAL SECURITY NUMBER
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------FOR COURT USE ONLY:
Attorney is GRANTED Pro Hac Vice Admission to the CJA Panel
Case Number: ______:_______ CR __________________
Judge:
____________________________________
Date: ________________
____________________________________________
Hon. Frederick J. Scullin, Jr., Chief Judge
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
w:\cja\CJA Panel PHV Application
01/03/2002
American LegalNet, Inc.
www.USCourtForms.com